US20060036165A1 - Tissue site markers for in vivo imaging - Google Patents

Abstract

The invention is directed biopsy site markers and methods of marking a biopsy site, so that the location of the biopsy cavity is readily visible by conventional imaging methods, particularly by ultrasonic imaging. The biopsy site markers of the invention have high ultrasound reflectivity, presenting a substantial acoustic signature from a small marker, so as to avoid obscuring diagnostic tissue features in subsequent imaging studies, and can be readily distinguished from biological features. The several disclosed embodiments of the biopsy site marker of the invention have a high contrast of acoustic impedance as placed in a tissue site, so as to efficiently reflect and scatter ultrasonic energy, and preferably include gas-filled internal pores. The markers may have a non-uniform surface contour to enhance the acoustic signature. The markers have a characteristic form which is recognizably artificial during medical imaging. The biopsy site marker may be accurately fixed to the biopsy site so as to resist migration from the biopsy cavity when a placement instrument is withdrawn, and when the marked tissue is subsequently moved or manipulated.

Description

RELATED APPLICATIONS
• The present application is a Continuation-In-Part of U.S. patent application Ser. No. 09/241,936, filed Feb. 2, 1999, and a Continuation-In-Part of U.S. patent application Ser. No. 09/343,975, filed Jun. 30, 1999. Each of the above referenced patent applications is incorporated by reference herein and the benefit of the filing date of each application is hereby claimed under 35 U.S.C. §1.20.
BACKGROUND OF THE INVENTION
• In diagnosing and treating certain medical conditions, it is often desirable to perform a biopsy, in which a specimen or sample of the suspicious tissue is removed for pathological examination, tests and analysis. As is known, obtaining a tissue sample by biopsy and the subsequent examination are typically employed in the diagnosis of cancers and other malignant tumors, or to confirm that a suspected lesion or tumor is not malignant. The information obtained from these diagnostic tests and/or examinations is frequently used to devise a therapeutic plan for the appropriate surgical procedure or other course of treatment.
• In many instances, the suspicious tissue to be sampled is located in a subcutaneous site, such as inside a human breast. Such removal of tissue samples may be accomplished by open surgical technique, or through the use of a specialized biopsy instrument and techniques. To minimize surgical intrusion into patient's body, it is often desirable to insert a small instrument, such as a biopsy needle, into the body for extracting the biopsy specimen while imaging the procedure using fluoroscopy, ultrasonic imaging, x-rays, MRI or any other suitable form of imaging technique. Examination of tissue samples taken by biopsy is of particular significance in the diagnosis and treatment of breast cancer. In the ensuing discussion, the biopsy and treatment site described will generally be the human breast, although the invention is suitable for marking biopsy sites in other parts of the human and other mammalian body as well.
• Periodic physical examination of the breasts and mammography are important for early detection of potentially cancerous lesions. In mammography, the breast is compressed between two plates while specialized x-ray images are taken. If an abnormal mass in the breast is found by physical examination or mammography, ultrasound may be used to determine whether the mass is a solid tumor or a fluid-filled cyst. Solid masses are usually subjected to some type of tissue biopsy to determine if the mass is cancerous.
• If a solid mass or lesion is large enough to be palpable, a tissue specimen can be removed from the mass by a variety of techniques, including but not limited to open surgical biopsy, a technique known as Fine Needle Aspiration Biopsy (FNAB) and instruments characterized as “vacuum assisted large core biopsy devices”.
• If a solid mass of the breast is small and non palpable (e.g., the type typically discovered through mammography), a relatively new biopsy procedure known as stereotactic needle biopsy may be used. In performing a stereotactic needle biopsy of a breast, the patient lies on a special biopsy table with her breast compressed between the plates of a mammography apparatus and two separate x-rays or digital video views are taken from two different points of view. A computer calculates the exact position of the lesion as well as depth of the lesion within the breast. Thereafter, a mechanical stereotactic apparatus is programmed with the coordinates and depth information calculated by the computer, and such apparatus is used to precisely advance the biopsy needle into the small lesion. Depending on the type of biopsy needle(s) used, this stereotactic technique may be used to obtain cytologic specimens, e.g., obtained through FNAB or it may be used to obtain histologic specimens e.g., obtained through coring needle biopsy. Usually at least five separate biopsy specimens are obtained from locations around the small lesion as well as one from the center of the lesion.
• The available treatment options for cancerous lesions of the breast include various degrees of mastectomy or lumpectomy and radiation therapy, as well as chemotherapy and combinations of these treatments. However, radiographically visible tissue features, originally observed in a mammogram, may be removed, altered or obscured by the biopsy procedure. In order for the surgeon or radiation oncologist to direct surgical or radiation treatment to the precise location of the breast lesion several days or weeks after the biopsy procedure was performed, it is desirable that a biopsy site marker be placed in or on the patient's body to serve as a landmark for subsequent location of the lesion site. While current radiographic type markers may persist at the biopsy site, an additional mammography generally must be performed at the time of follow up treatment or surgery in order to locate the site of the previous surgery or biopsy. In addition, once the site of the previous procedure is located using mammography, the site must usually be marked with a location wire which has a barb on the end which is advanced into site of the previous procedure. The barb is meant to fix the tip of the location wire with respect to the site of the previous procedure so that the patient can then be removed from the confinement of the mammography apparatus and the follow-up procedure performed. However, as the patient is removed from the mammography apparatus, or otherwise transported the position of the location wire can change or shift in relation to the site of the previous procedure. This, in turn, can result in follow-up treatments being misdirected to an undesired portion of the patient's tissue.
• As an alternative or adjunct to radiographic imaging, ultrasonic imaging and visualization techniques (herein abbreviated as “USI”) can be used to image the tissue of interest at the site of interest during a surgical or biopsy procedure or follow-up procedure. USI is capable of providing precise location and imaging of suspicious tissue, surrounding tissue and biopsy instruments within the patient's body during a procedure. Such imaging facilitates accurate and controllable removal or sampling of the suspicious tissue so as to minimize trauma to surrounding healthy tissue.
• For example, during a breast biopsy procedure, the biopsy device is often imaged with USI while the device is being inserted into the patient's breast and activated to remove a sample of suspicious breast tissue. As USI is often used to image tissue during follow-up treatment, it may be desirable to have a marker, similar to the radiographic markers discussed above, which can be placed in a patient's body at the site of a surgical procedure and which are visible using USI. Such a marker enables a follow-up procedure to be performed without the need for traditional radiographic mammography imaging which, as discussed above, can be subject to inaccuracies as a result of shifting of the location wire as well as being tedious and uncomfortable for the patient.
SUMMARY OF THE INVENTION
• The invention is directed generally to devices and methods of marking a biopsy site, so that the location of the biopsy cavity is readily visible by ultrasonic imaging, as well as by conventional imaging methods, such as x-rays. The biopsy site marker of the invention is a persistent marker which may be identified and located by ultrasound visualization.
• The biopsy site markers of the invention have a body conformation to enhance acoustical reflective signature or signal. The body conformation may include boundaries of high contrast of acoustic impedance to enhance ultrasound reflection. The markers are readily detected by USI and present a substantial acoustic signature from a marker with small physical dimensions or size. Because of the high acoustic reflectivity of the markers of the invention, the marker size may be reduced to dimensions determined by the physical limits of the imaging system itself, e.g., the ultrasound (US) beam width, without requiring a larger or excessive marker size to reflect sufficient US energy to be noticeable.
• In one embodiment, the biopsy site markers of the invention have a characteristic body shape which is recognizably artificial during medical imaging, so as to be readily distinguishable from biological features within the marked tissue. In particular, the markers are readily distinguishable in the various imaging procedures from diagnostically important tissue features, such as lines of calcifications which frequently are signs for a developing malignancy. The marker body shape may have one or more distinct features which may be visualized in different marker orientations. The shape may correspond to a generally known symbol, so a to enhance recognition.
• In another embodiment, the markers of the invention have a body conformation to enhance the acoustic signature or signal, so that the body has high acoustic reflectivity when situated in tissue. The acoustic reflective signature of the markers depends on a number of factors. The marker may comprise a composition which presents at least one boundary of high contrast in acoustic impedance to incident US energy, effectively reflecting the US energy to be received by the imaging system. Acoustic impedance (AI) of a material is equal to the product of the characteristic density (ρ) of the material and the acoustic velocity (c) in the material, (i.e., AI=ρ×c). As an incident US beam encounters a boundary with a large change in acoustic impedance (e.g., at the marker surface or internal to the marker), much of the US energy is effectively reflected.
• Different types of tissue have a wide range of acoustical impedance, for example lung tissue with high air content having low acoustical impedance as compared to bone tissue having high mineral content. However, for uses such as biopsy site marking in typical mammalian soft tissue of high aqueous content, the typical range of tissue acoustical impedance is intermediate these extremes. The composition and body conformation of the markers of the invention may be selected so as to provide boundaries of high contrast of acoustic impedance with respect to the particular tissue site of use.
• In an embodiment of the invention, the marker may have a composition in which a base or matrix substance of the marker body (e.g., stainless steel) has an acoustic impedance substantially higher than the tissue at the marked body site. For example, typical bio-compatible metal materials, such as stainless steel, titanium, platinum and the like, generally have acoustic impedance values in the range of 15 to more than 30 times that of typical soft tissue of high aqueous or fatty content. The high acoustic impedance of the marker body base material relative to the surrounding tissue presents a reflective interface to an incident US beam.
• A suitable marker body composition with acoustic impedance substantially higher than the tissue at the marked body site is 316L stainless steel. Other alternative compositions, such as compositions of bio-compatible metals, ceramics, metal oxides or polymers, or composites or mixtures of these materials, may be suitable. The marker body may also be radio-opaque.
• In another embodiment of the invention, the marker may have a composition in which marker body includes one or more (preferably a large plurality) of internal bounded spaces, such as voids, pores, discontinuities, inclusions, bubbles and the like. These internal spaces preferably contain or entrain air or other gases.
• Air has an extremely low acoustic impedance relative to the marker body base or matrix substance. This is true even for matrix materials which themselves have acoustic impedance close to that of the surrounding tissue (e.g., some bio-compatible polymers). The marker body presents internal boundaries of high contrast in acoustic impedance, i.e., at the boundary between the matrix and each internal air-filled space. The marker body thus presents plurality of reflective interfaces to an incident US beam.
• Alternatively or in combination with to the materials of high acoustic impedance described above, a marker body with internal voids or air spaces may, if desired, comprise a matrix or base composition which has an acoustic impedance close to that of the tissue at the marked body site, since the air or other gas within the internal spaces provides a dramatic contrast to the matrix material. Suitable bio-compatible materials include polyethylene, polytetrafluoroethylene, PEBAX (made by Autochem Corp.), and the like.
• The body matrix material can have a hydrophobic composition or be treated to be hydrophobic. The surface area bounding internal open-cell pores should be hydrophobic so as to resist the displacement of air or other gases in the pores by aqueous fluid from the surrounding tissue, particularly in the case of relatively large pore or space size.
• In some embodiments of the invention, the markers can include surface characteristics which enhance the acoustic signature and improve visibility under US imaging, as opposed to a smooth, rounded body surface. In order to provide enhanced ultrasound imaging visibility from all directions of US impingement, the biopsy marker can have a plurality of reflective external surfaces. By making the surface of an object lobulate, multifaceted or otherwise irregular, more reflective surfaces are created, and a brighter acoustic signature is achieved.
• For example, a smooth solid sphere provides at least some reflective surface oriented in each direction, but the reflection is achieved over a small portion to the area of the sphere, thus producing an unremarkable acoustic signature. In contrast, an object of the same composition and average diameter as the sphere, but with a highly irregular surface texture, a much brighter acoustic signature or signal is achieved. Thus, the by providing more reflective surfaces of differing or random orientation, the markers appears brighter in US imaging.
• The signal-enhancing body conformation may include non-smooth surface texture, such as a porous, frosted, matte, pitted, peened, or scratched surface texture, and the like. The body conformation may also include a multi-element surface contour, such as a faceted, multi-planar, lobulate, coiled, grooved, folded, or inlet surface contour, and the like. Such external body conformations may be used in combination with one another and in combination with the internal discontinuities or air spaces described above.
• The body length, diameter or other characteristic scale dimensions of some embodiments of the biopsy marker of the invention may be of a range of sizes. The optimum dimensions of the body will depend upon the specific selected factors which influence acoustic signature as described herein, such as material impedance, surface contours, surface texture, and internal conformation. In addition, the optimum size may depend upon such factors as the type of ultrasound imaging/visualization system used, its imaging resolution, the operating ultrasound frequency, and the biophysical nature of the tissue of interest.
• The body dimensions may be selected so as to be large enough to provide a distinct, recognizable marker image within the tissue biopsy site, when visualized under the particular imaging system and operating conditions of use. The body dimensions may also be selected to be small enough to avoid masking or obscuring diagnostically important tissue features. Thus different marker dimensions may be selected to suit particular biopsy site tissue types, and to suit particular known and future medical imaging equipment.
• In terms of over-all size, it is desirable that the marker have at least one dimension which is about as large as or greater than the beam width of the USI system with which it is to be visualized. Typically, for current USI systems, the marker will have at least one dimension of about 1 mm or greater, and preferably of at least about 1.5 mm.
• In addition, for convenience in applying the marker to the tissue site, the specific marker dimensions and shape may be selected so as to accommodate the dimensions of a particular known or novel biopsy needle device or sampling apparatus, while still achieving a distinct and recognizable marker image under medical imaging as placed at the tissue site. By selecting a marker size and shape to fit within the internal diameter of a biopsy needle or sampling device, the marker may be implanted or applied to the biopsy cavity during the course of the biopsy procedure, following sample recovery but prior to removal of the biopsy device. For example, the marker of the invention may have a size and shape selected to permit application of the marker through the hollow interior space of a vacuum assisted large core biopsy device, such as is commercially available from Johnson and Johnson, Ethicon Endosurgery Division. The small physical size of the markers of the invention relative to their acoustic reflectivity permits fitting the markers to a wide variety of biopsy devices.
• In terms of the size of features, including external or internal pores, texture features, facets and the like, it is preferable that these features have a characteristic dimension approximately equal to or exceeding the wavelength of the US beam of the imaging system. For example, with current imaging systems, for a marker with internal air-filled pores, the pore size is typically from about 1 micrometer to 100 micrometers and preferably from about 5 micrometers to 40 micrometers, to provide high reflectivity of the incident US energy.
• Optionally, some embodiments of the biopsy site marker of the invention may have elements which assist in accurately fixing the marker to the biopsy site so as to resist migration from the biopsy cavity. Such migration can occur when a placement instrument is withdrawn, and when the marked tissue is subsequently moved or manipulated, as for example when a breast is decompressed and removed from the mammography apparatus. In one embodiment, one or more tissue engaging structures or haptic elements are mounted or affixed to the main marker body, so as to resist movement or migration of the marker from the biopsy site in which it has been implanted during use.
• In another embodiment, the biopsy site marker may comprise a pellet-shaped element which encapsulates the high impedance marker body, and assists in resisting migration. The encapsulating pellet may be of a composition, such as gelatin, which is absorbed or dissipated over time, leaving the persistent marker body at the tissue site. In yet another embodiment, the marker body (and/or the optional encapsulating element) may include an adhesive component to cause the marker body (or encapsulating element) to adhere to adjacent tissue within the biopsy site.
• A method of the invention for marking a tissue site of interest can include implanting one or more of the markers of the invention, such as one of the exemplary marker embodiments described herein, in or adjacent to a tissue site of interest, e.g., within a biopsy cavity. The marker may then be visualized in situ, such as for purposes of subsequent medical and surgical procedures. The visualization may be by various known medical imaging systems and methods, and in particular may be visualized by known USI systems.
• Biopsy markers of the invention can be deposited in accordance with the various methods and techniques utilized in the state of the art. One technique of applying the biopsy markers of the invention is to place or deposit them in a biopsy cavity that is created with a vacuum assisted large core biopsy device. An applicator particularly suitable for insertion of the biopsy site markers of the invention is described below. However, it should be understood that the biopsy markers of the invention can be used without the exemplary applicator device described herein. The biopsy marker applicator disclosed in co-pending application Ser. No. 09/343,975 filed Jun. 30, 1999, may be used to apply the markers of the current invention to a biopsy site. The dimensional size of the applicator device (particularly the inside diameter) may be adjusted to correspond to a selected diameter or characteristic dimension of the biopsy site marker embodiment of the present invention.
• These and other advantages of the invention will become more apparent from the following description when taken in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective view of a human breast partially cut away having a lesion from which a biopsy specimen has been removed, and showing a marker applicator syringe and introduction cannula operatively positioned for introduction of a biopsy site marker embodying features of the present invention into the cavity created by removal of the biopsy specimen;
• FIGS. 2A-2E show exemplary conformations and shapes of sintered or porous metal site marker embodiments of the invention,FIG. 2A showing a sintered body having irregular pores,FIG. 2B showing a bubble-filled marker body,FIG. 2C showing a cylindrical-shaped marker,FIG. 2D showing a cruciform-shaped marker andFIG. 2E showing a polyhedral shaped marker.
• FIG. 3 shows a marker having the shape of a Greek letter.
• FIG. 4 shows an example of the alternative coil-shaped embodiment of the marker of the invention;
• FIG. 5 shows an example of the alternative spheriod embodiment of the marker of the invention;
• FIG. 6 is a schematic view (scale exaggerated for clarity) of an exemplary biopsy tissue site, in this case a human breast, showing a biopsy cavity of the type obtained by a known type of vacuum assisted large core biopsy sampler device, into which a biopsy marker or markers embodying features of the invention are deposited by a marker applicator device inserted through the outer cannula of the large core biopsy sampler.
• FIG. 7 shows schematically an embodiment of the invention including one or more haptic elements and/or an adhesive component, for resisting migration of the marker within the tissue.
• FIG. 8 shows schematically an embodiment of the invention including an encapsulating element and optional adhesive component, for resisting migration of the marker within the tissue.
• FIG. 9A is a schematic view of a biopsy sampler device at a tissue site with an alternative marker delivery system.
• FIG. 9B is a perspective view of the petalled distal end of the delivery device shown inFIG. 9A.
• FIG. 9C is a perspective view of the distal end of the delivery device shown inFIG. 9A with a marker exiting the petalled distal end.
• FIG. 10 is a perspective view of an alternative marker having a gel body with a radiopaque collar disposed about the gel body.
DETAILED DESCRIPTION OF THE INVENTION
• The following detailed description, and the accompanying drawings to which it refers are provided for purposes of exemplifying and illustrating representative examples and embodiments of the invention only, and are not intended to limit the scope of the invention in any way, and do not exhaustively illustrate and describe all possible embodiments and configurations in which one or more features of the present invention may take physical form.
• All patents and patent applications cited in this specification are herein incorporated by reference as if each individual patent or patent application were specifically and individually indicated to be incorporated by reference.
• FIG. 1 shows the use and insertion into a biopsy site of any one of the biopsy site marker embodiments of the invention described herein.FIG. 1 is a perspective view of ahuman breast2 having a lesion3 from which a biopsy specimen has been removed, thereby forming abiopsy cavity4 within the lesion3, into which abiopsy site marker10 of the of the present invention is implanted. The figure shows anouter cannula12 with the distal end thereof operatively positioned within thebiopsy site4. Theouter cannula12 has been inserted percutaneously into the lesion3 and a biopsy needle (not shown) has been passed through theouter cannula12 and used to remove a biopsy specimen from the center of the lesion.
• Syringe-likemarker application device13 includes a marker introduction tube orinner cannula14. After removal of the biopsy needle (not shown), themarker introduction cannula14 has been passed through theouter cannula12 such that inner cannuladistal end14dis located within thebiopsy cavity4, themarker10 being housed withincannula14.Piston15 ofmarker applicator13 has anextension16 which passes through the interior ofinner cannula14. Upon depressingpiston15,extenuation16pushes marker10 outward through anopening17 in thetip14dofinner cannula14 into thecavity4.
• Theouter cannula12 may be an outer tube element of a conventional vacuum assisted large core biopsy device, which has been left in place to assist in site marker application following biopsy sample recovery. One example of aapplicator syringe device13 is described in further detail below with respect toFIG. 5.
• FIGS. 2A, 2B,2C,2D and2E show exemplary internal conformations and shapes of the sintered or porous site marker embodiments of the invention20a-20erespectively.
• FIGS. 2A and 2B show schematic cross sections of a alternative porous or sintered marker body embodiments.FIG. 2A is a cross section of a sinteredsite marker embodiment20a. The matrix orbase material21 encloses a plurality of irregular shapedpores22 distributed within thebody20a, preferably throughout the body volume. The term “sintered” will be used to describe the porous body conformation, it being noted that conventional methods of production other than sintering may be employed to produce a material containing internal voids, pores, discontinuities, inclusions, bubbles and the like.
• Thepores22 may be open celled, in which thepores22 generally intersect or communicate with one another and the marker body exterior, which may give the body surface23 a pitted texture on the scale of the pore size. Alternatively, the pores may be closed celled, in which thepores22 generally do not intersect one another or the exterior. In the event that thepores22 communicate with themarker exterior23, thematrix material21 is preferably hydrophobic (or treated to have hydrophobic surfaces) to resist displacement of air entrained inpores22.
• The base ormatrix composition21 has may be of high acoustic impedance relative to the surrounding tissue (not shown). Sintered metal material may be shaped and sintered from commercially available metallic powders comprising a metal or mixtures of metals, using conventional sintering and forming techniques to produce body of selected shaped, and selected pore size and surface texture, so as to enhance acoustic reflectivity. The porosity of the sintered metal provides an irregular surface texture as well as internal voids. A suitable bio-compatible material is sintered 316L stainless steel, and suitable sintered stainless steel stock is commercially available in various forms, for example from the Mott Corporation. The sintered stock may be economically cut and shaped by conventional methods. Sintered stainless steel stock is commercially available with controlled pore size, selectable over a range of pore sizes. Thepores22 of thesintered body20amay vary over a range of pore sizes, and is typically from about 1 micrometer to 100 micrometers and preferably from about 5 micrometers to 40 micrometers.
• In addition to sintered metal, alternative bio-compatible, impedance materials may be included or substituted, such as ceramics, metal oxides, polymers or composites/mixtures of these materials, which may be configured to have a generally distributed internal porosity and porous surface texture. Thus, themarker body20amay comprise a matrix orbase composition21 which has an acoustic impedance close to that of the tissue at the marked body site, since the air or other gas within the pores orinternal spaces22 provides a dramatic contrast to thematrix material21. Suitable bio-compatible materials include polyethylene, polytetrafluoroethylene, PEBAX (made by Autochem Corp.), and the like. Such porous materials may be formed by conventional methods, such as heat bonding of polymer powders, extrusion and the like.
• FIG. 2B is a schematic cross section of an alternative site marker embodiment20b. The matrix orbase material24 encloses a plurality of inclusions, suspended particles or bubbles25 distributed within the body20b, preferably throughout the body volume. Theinclusions25 may be low-density or gas-filled particles, such as foamed-in-place bubbles, micro-beads, expanded beads, and the like, which have an acoustic impedance substantially lower than thematrix material24. Thematrix material24 may as in the example ofFIG. 2A.
• FIGS. 2C and 2D show exemplary shapes of the sintered or porous site marker embodiments of theinvention20cand20drespectively.FIG. 2C shows schematically acylindrical sintered marker20c. Themarker20ccomprises a generally cylindrical body having a diameter d and length l. The body may have diameter d of from 0.5 to 5 mm, and preferably about 1.5 mm. The length l may be from about 1 diameters to about 10 diameters, and preferably from about 5 to 7 diameters. This biopsy site marker produces a distinct, recognizable, marker image of artificial appearance when implanted at a depth of about 2 to 4 cm in human breast tissue, and visualized by a commercially available Accuson 128 US imaging system with an L7 transducer.
• FIG. 2D illustrates amarker body20dhaving a polyhedral form of multiple intersectingflat surfaces26,27 and28.
• FIG. 2E shows a cruciform shapedmarker20ehaving cruciform cross-section having four longitudinal fin-like portions29, which may be aligned at right angles to one another and joined at the longitudinalcentral axis30 providing a selectable number of side facets (e.g., hexagonal cross-section). Optionally,medial web portions31 may span laterally and join betweenadjacent fins29, thewebs31 preferably being aligned perpendicularly to thefins29. In the example shown, there are foursuch web portions31 positioned at about mid-length of thebody20e, so that eachfin29 is joined by a pair ofwebs31, one on each side, to each adjacent fin. Thus, the planes of the intersecting fins and webs form a pattern of eight mutually-perpendicular “corner reflectors”32. The length l and characteristic cross-section dimension c may be as described with respect to the embodiments ofFIGS. 2C and 2D.
• FIG. 3 illustrates yet another alternative where the marker body is shaped to have the form, under ultrasound or radiological visualization, preferably both, of a familiar symbol or letter, to by easily recognizable as an artificial shape which is the lower-case Greek letter Gamma (y), which when visualized in a biopsy site bears a resemblance to a familiar breast-cancer-awareness symbol.
• FIG. 4 shows schematically analternative coil marker30 of the invention. Themarker30 comprises a generally helical coil-like body formed from one or more lengths of fine wire and/orfiber31. Thecoil30 has a generally cylindrical overall form. As with the other biopsy site marker embodiments of the invention, the optimum dimensions of the coil shaped marker embodiment will depend on such factors as the type of visualization system used, its imaging resolution, and the physical nature of the biopsy tissue region. The coil length l and diameter d may be of a range of sizes, selected so as to be large enough to provide a distinct, recognizable ultrasound marker image within the tissue biopsy site, and small enough to avoid masking or obscuring diagnostically important tissue features. For example, the coil diameter d may be from 0.5 to 5 mm, and preferably about 1.5 mm. The coil length l is typically from about 1 coil diameters to about 10 coil diameters, and preferably from about 5 to 7 coil diameters.
• The helical turns of the coil provide a body surface contour including a outerhelical groove32 and innerhelical groove33 on the coil surfaces (more than one such groove for a multiple helix). The grooved coil body surface includes a plurality of lobes and crevices on the exterior of the coil which enhance acoustic reflectivity. In addition the similarly lobed internal surfaces of the coil provide additional reflectivity. Optionally, the coil may be given a “frosted” or textured surface, such as by particle blasting in the manner of the spheroid marker described above. A uniform coil embodiment has a shape which is markedly artificial in appearance under conventional visualization methods, and is not easily confused tissue features of biological origin.
• The coil may comprise afine wire31 of a material of high acoustic impedance relative to the tissue of the site, and may optionally be radio-opaque. Suitable materials are biologically compatible metals, such as stainless steel, titanium, platinum, palladium, alloys thereof and the like. The coil may alternatively comprise a composite of different materials, such as a composite of metal and polymeric materials. The coil may be wound about a central core of the same or different composition. Coil stock of suitable material, helical form and diameter is available commercially, and may be cut to a selected length by conventional means. A suitable material is 316 L stainless steel surgical embolization coil currently used in arterial embolism repair procedures, e.g.,Cook 4 mm diameter embolization coil MWCE-25-2.5-4 of 316L stainless steel and Dacron. Other suitable embolization coil stock is available in a range of coil diameters. This biopsy site marker produces a distinct, recognizable marker image as implanted at a depth of about 2 to 4 cm in human breast tissue, when visualized by a commercially available Accuson 128 US imaging system with an L7 transducer.
• FIG. 5 shows schematically thealternative spheroid marker40 of the invention having a generallyspherical body40. Note that the porous or sintered marker embodiments ofFIGS. 2A-2D may be spherical also. However, the embodiment ofFIG. 5 is a non-porous example, and thebiopsy site marker40 comprises a high acoustic impedance, biologically compatible material, such as 316 L stainless steel and titanium, or radiopaque metals such as platinum, palladium, or the like. Non-spherical shaped bodies may be used, however, metallic spheres of suitable materials are readily commercially available, and have a shape which is markedly artificial in appearance under conventional visualization methods, i.e., not easily confused tissue features of biological origin.
• The generally spherical body may have a diameter d selected so as to be large enough to provide a distinct, recognizable ultrasound marker image within the tissue biopsy site, and small enough to avoid obscuring tissue features. As with the other biopsy site marker embodiments of the invention, the optimum size of the sphere will depend on such factors as the type of visualization system used, its imaging resolution, and the physical nature of the biopsy tissue region. For example, the sphere diameter d is typically be from about 1 mm to about 4 mm, and preferably from about 1.5 mm.
• Thespherical body40 may include a pitted, matte, peened or frosted surface texture41, which may be produced by conventional particle blasting or peening techniques. For example, the sphere may be blasted with glass beads of about 100 micrometer diameter to produce a frosted surface. In another example, the sphere may be blasted with aluminum oxide abrasive particles of about 25 micrometer diameter to produce a frosted surface. The frosted surface41 thus produced provides enhanced acoustic reflectivity in comparison to the untreated, smooth sphere. Other conventional texturing, pitting or faceting methods may alternatively be used to produce a frosted or irregular surface texture.
• This biopsy site marker produces a distinct, recognizable marker image of artificial appearance when implanted at a depth of about 2 to 4 cm in human breast tissue, and visualized by a commercially available Acuson 128 US imaging system with an L7 transducer.
• FIG. 6 shows schematically in cut-away section an exemplarymarker applicator device50 configured to be operated in association with a conventional vacuum assisted largecore biopsy device6. The dimensional size of the applicator device (particularly the inside diameter) may be adjusted to correspond to the selected diameter or characteristic dimension of the biopsy site marker to be deposited. In this connection it should be understood that the biopsy markers of the invention can be used without this applicator, and can be deposited in accordance with the various methods and techniques utilized in the state of the art.
• Theapplicator50 comprises an elongatedcylindrical body52 which has an outer diameter selected so that it fits, and may be inserted through, the outer cannula7 of vacuum assisted largecore biopsy device6. As shown inFIG. 6, the outer cannula7 is inserted through the biopsy incision into thebiopsy cavity4 previously formed in the patient'stissue site8, e.g., a human breast in the case of a breast biopsy.
• Thecylindrical body52 has an interior cavity and apiston54 that fits and slides back and forth in the elongatedcylindrical body52. The proximal end of the outer cannula7 may be provided with rectangularly shaped handle56 the orientation of which indicates to the operator the orientation of theopening9 provided in the distal end of the cannula7. Thecylindrical body52 may have an enlarged finger disk or handle57 at its outer (exterior to the patient) end which permits a user (not shown) to operate or move thepiston54 within thecylinder52 ofapplicator50. the orientation of theelongated finger disk57 indicates the orientation of theopening58 of body53 adjacent its other, closed end59 (internal within biopsy cavity). Theopening58 is configured to form a ramp in the side of thetube52.
• In this connection it should be understood that the selected dimensions of thetube52 are coordinated with the dimensions of thepiston54 and with the cannula7 of the vacuum assisted largecore biopsy device6, thus permitting thetube52 to both fit within cannula7 and to contain one or more markers of theinvention10 within the inside diameter ofcylinder52. The cylinder ortube52 and thepiston54 may be made from any appropriate medical grade plastic material, such as high density polyethylene or PEBAX, made by the Autochem Corporation.
• In one method of implanting thebiopsy markers10 of the present invention, thetube52 is loaded with one or more ofmarkers10. Themarkers10 may be any of the embodiments of the invention described above, and is shown schematically as a cylindrical object. Optionally, in addition to themarkers10, pellets composed of various other materials may be inserted along with one of the embodiments of the biopsy markers of the present invention described herein. For example, gelatin pellets of the type disclosed in our above referenced co-pending application Ser. No. 09/343,975 may be inserted in conjunction with thebiopsy markers10 of the present invention.
• With themarkers10 in thetube52 and thetube52 and cannula7 inserted into thebiopsy site4, theopening58 in thecylinder52 is moved into alignment with the opening orport9 of the in the internal end of cannula7 ofbiopsy sampler6. Thepiston54 is pressed inward by the operator so that the marker ormarkers10 are expelled from thetube52 through the ramp shapedopening58 as thepiston54 is pushed into the cylinder ortube52. Themarkers10 are thereby extruded throughopening59 andport9 into thebiopsy cavity4. Theapplicator50 andbiopsy device6 are subsequently withdrawn.
• FIG. 7 shows schematically analternative marker60 of the invention including one or more optional tissue-engaging orhaptic elements62 for resisting migration of the marker from the biopsy site. An exemplarycylindrical marker body10 is shown, although each embodiment of the biopsy site marker of the invention described above may optionally comprises one or more such tissue engaging structures. Thehaptic elements62 may comprise an wire-like material fixed to themarker body10 at the proximalhaptic end64 and extending outward from themarker body10. The haptic62 may be looped back at its hook-liketerminal end66.
• The haptic62 assists in resisting migration of the marker from the biopsy cavity, during initial placement, i.e., it engages the adjacent tissue to resist being sucked back towards the applicator when the applicator is withdrawn. The haptic also resists migration during later movement, flexure or manipulation of the tissue surrounding the biopsy site, such as when a patient's breast is decompressed upon removal from a mammography device. Optionally, themarker body10 may include anadhesive component68 coated onto its surface to cause the marker body to adhere to adjacent tissue within the biopsy site.
• FIG. 8 shows schematically thealternative marker70 of the invention including an encapsulatingelement72 and optional adhesive layer orcomponent74, for resisting migration of the marker within the tissue. An exemplarycylindrical marker body10 is shown, although each of the biopsy site marker of the invention described above may optionally comprise a pellet-shaped encapsulating element.
• The pellet-shapedencapsulating element72 is disposed surrounding themarker body10 and may fully or partially enclose the marker body. The encapsulatingelement72 may be of lower impedance than themetallic marker body10. Suitable materials are gelatin or reconstituted collagen material, polymers, or mixtures or composites thereof. Anoptional adhesive component74 is shown coating the external surface of the encapsulating element, but may be included within the composition the encapsulatingelement72.
• FIG. 9A illustrates analternative device80 for delivering markers to a biopsy site which includes anelongated tube81, ahandle82 on the tubes proximal end and a closed distal end having a plurality of leafs orpetals83 as shown in more detail inFIG. 9B. As shown inFIG. 9C, thepetals83 open up to allow amarker84 to be discharged into thebiopsy site85 as shown inFIG. 9C. Thedevice80 has an elongated plunger orpiston86 slidably disposed within thetube81 for pushing one ormore markers84 through the petalled distal end by pressing on theknob87 on the proximal end of theshaft86. The orientation of thebody88 on theshaft86 gives the operator an indication of the orientation of the shapeddistal end89.
• FIG. 10 illustrates analternative marker90 which has an elongated cylindrically shaped body ofgel91 surrounded with ametallic band92 which is preferably formed of radiopaque material. Theband92 may conpletely or only partially surround the body ofgel91.
• In any of the above-described embodiments of the invention, the marker body (and/or the optional encapsulating element) may include an adhesive component to cause the marker body (or encapsulating element) to adhere to adjacent tissue within the biopsy site. The adhesive component may comprise a biocompatible adhesive, such as a polyurethane, polyacrylic compound, polyhydroxymethacrylate, fibrin glue (e.g., Tisseal™), collagen adhesive, or mixtures thereof.
• While particular forms of the invention have been illustrated and described, it will be apparent that various modifications can be made without departing from the spirit and scope of the invention. Accordingly, it is not intended that the invention be limited to the specific embodiments illustrated. It is therefore intended that this invention to be defined by the scope of the appended claims as broadly as the prior art will permit, and in view of the specification if need be.

Claims (14)

1. An intracorporeal site marker for marking a selected site within tissue of a patient's body, comprising:

(a) an ultrasound detectable body including boundaries having a high contrast in acoustical impedance when the marker is placed in tissue of the selected site, so as to efficiently reflect ultrasound during ultrasound imaging; and

(b) a body shape which is recognizably artificial when the marker is subject to ultrasound or X-ray imaging, so as to be readily distinguishable from biological features within the tissue site.

2-41. (canceled)

42. An intracorporeal site marker assembly for marking a selected site within tissue of a patient, comprising:

a) a delivery tube having a discharge end and an inner lumen extending to the discharge end,

b) a plurality of marker bodies which are disposed within the inner lumen of the delivery tube and which are formed at least in part of bioabsorbable material that dissipates over time at the intracorporeal tissue site; and

c) at least one of the marker bodies having a metallic object which is recognizably artificial when the marker body is remotely imaged and which is persistent at the intracorporeal site.

43. The intracorporeal site marker assembly ofclaim 42 wherein a piston is slidably disposed within the inner lumen of the delivery tube proximal to the plurality of marker bodies.

44. The intracorporeal site marker assembly ofclaim 42 wherein the marker bodies have transverse dimensions of about 0.5 to about 5 mm.

45. The intracorporeal site marker assembly ofclaim 44 wherein the marker bodies have longitudinal dimensions of about 1 to about 10 times the transverse dimensions thereof.

46. The intracorporeal site marker assembly ofclaim 42 wherein marker bodies have cylindrical shapes.

47. The intracorporeal site marker assembly ofclaim 42 wherein at least one of the marker bodies has a porous structure.

48. The intracorporeal site marker assembly ofclaim 47 wherein the porous marker body has a pore size of about 1 to about 100 micrometers.

49. The intracorporeal site marker assembly ofclaim 48 wherein the porous marker body has a pore size of about 5 to about 40 micrometers.

50. The intracorporeal site marker assembly ofclaim 42 wherein the bioabsorbable material is selected from the group consisting of gelatin, collagen, polylactic acid, polyglycolic acid, polylactic-polyglycolic acid co-polymer, polycapriolactone, mixtures and composites thereof.

51. The intracorporeal site marker assembly ofclaim 42 wherein the tubular member contains up to 30 marker bodies.

52. The intracorporeal site marker assembly ofclaim 42 wherein the tubular member contains eight marker bodies.

53. The intracorporeal site marker assembly ofclaim 42 wherein the metallic object is recognizably artificial when the marker body is remotely imaged by ultrasound or X-ray imaging

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